Snoopy, 10-year old, M/N, beagle named Snoopy presented with a temperature of 104.6F, anorexia, and lethargy. Snoopy had a history of dietary indiscretions and one day prior to presentation, an engorged tick was removed from his ventrum. Thoracic/abdominal radiographs and chemistry unremarkable. CBC: HCT 37%, WBC 5.99 K/uL, PLT 101,000/ul. Following IV antibiotic therapy overnight, Snoopy ate canned food, remained febrile, and continued to be lethargic. FNA of a prescapular lymph node was initially submitted, followed by blood smear review.
Scopio Practice Tip
Blood smear review is a great use of Scopio. CBC reports can be attached via the paperclip icon! In this case, a non-diagnostic lymph node aspirate was received and repeat submission offered at no charge, but this was also non-diagnostic. The clinical pathologist contacted the clinic in real time, via the Scopio chat feature, and requested a blood smear due to potential for tick-borne disease. Additional information provided by the clinic via chat included that an in-house Snap 4Dx test was negative, which is another reason to do a blood smear review. In acute anaplasmosis/ehrlichiosis, antibody based tests will be negative, but this is when morula are visible within leukocytes. After a non-diagnostic FNA sample, the blood smear revealed the diagnosis!
Webcam images with user chosen scan area denoted by thin green line.
Pink box includes monolayer & feathered edge, areas necessary for complete interpretation.
Lymph node aspirates
Interpretation: Leukopenia with probable rickettsial infection, probable mild thrombocytopenia, possible mild anemia.
How do we avoid qualifying language like “probable?” For blood smear review, including a recent CBC is essential to avoid speculative language, and in any case, complete history with clinical suspicion and diagnostic test results allows for more definitive interpretation.